title: Understanding referral patterns to an epilepsy clinic: professional perceptions of factors influencing the referral of older adults.
abstract: OBJECTIVE
  The number of older patients with epilepsy has been increasing steadily, however older adults have been shown to be referred less commonly to specialist epilepsy services than younger individuals. The aim of this study was to explore staff perceptions of why older adults may be under-represented in epilepsy clinics.
  
  
  METHODS
  We conducted 19 interviews with potential referrers and staff providing services including GPs, geriatricians, neurologists, service and clinical managers and epilepsy nurses. Data were analysed using principles of thematic analysis to identify and examine recurring views and perceptions.
  
  
  RESULTS
  Seven key factors were suggested as leading to under-referral of older adults: patient difficulties accessing hospital; patient reluctance to attend clinics; unclear referral pathway; complex differential diagnosis; gaps in referrer knowledge; the length of time since onset; and particular characteristics of older patients.
  
  
  CONCLUSIONS
  While recognising the limitations of the study we believe that it provides valuable further understanding of referral patterns to specialist epilepsy services. Future studies will need to determine whether the assumptions made by the interviewees about the thoughts and wishes of older people with epilepsy were correct or not. To understand this issue more clearly, we plan to sample the views of patients directly. Of particular concern are assumptions regarding older patient's willingness to attend appointments and about the impact of seizures on the life of an older adult.
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK. Electronic address: l.blank@sheffield.ac.uk.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Blank
authors.forename: Susan
authors.initials: S
authors.lastname: Baxter
authors.forename: Wendy
authors.initials: W
authors.lastname: Baird
authors.forename: Markus
authors.initials: M
authors.lastname: Reuber
mesh_terms: D000368:Aged; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D015577:Geriatric Assessment; D006281:Health Occupations; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D010465:Perception / Q000502:physiology*; D012017:Referral and Consultation
keywords: Elderly; Epidemiology; Epilepsy; Geriatrics; Qualitative